1/ Covid (@UCSF) Chronicles, Day 30
Better @ucsfhospitals, w/ 17 Covid cases, 2 on vents. If you’re following, you may have done math: @ucsf, 11 intubated pts, 1 death (9% mortality rate). 2 pts still tubed so % could rise, but to max 27%, much better than published #s, ~40-90%
Better @ucsfhospitals, w/ 17 Covid cases, 2 on vents. If you’re following, you may have done math: @ucsf, 11 intubated pts, 1 death (9% mortality rate). 2 pts still tubed so % could rise, but to max 27%, much better than published #s, ~40-90%
2/ SF also trending better. Only 6 diagnoses in past d (in city of 883K!). No new deaths, total of 17 deaths since start in SF. Certainly seems like we’re on downslope. Also, by now we would have expected to see some hospitalizations from homeless outbreak; very few so far
3/ More media today – did a “3 Mayors and a Doctor” @facebook chat, with Mayors of SF, San Jose & Oakland bit.ly/2z9dPaL (sorry, spotty Zoom at times). Also did @BungerKCBSRadio call-in bit.ly/3ewnLuX; amazing how many ?s concern safety of eating & shopping
4/ It’s Thurs, so I’ll summarize today’s great @ucsf grand rounds, video: bit.ly/2yih6Ej. Talks @Rutherford_ucsf on epi & next stage, @KBibbinsDomingo on Covid/disparities, @annieluet on therapies. Also @mkushel & @tomasdiaz, one of 20 @ucsf MDs/RNs volunteering in NYC.
5/ At 7:15, I asked Tomas: what’s he seen that’s most surprising? A) Hearing NYC clinicians talk matter-of-factly about wildly abnormal things. “They’re talking about >200 ventilated patients [many on regular hospital floors, not ICU]…[like] that’s just a fact.” Just remarkable
6/ At 10:03, I asked Tomas why he volunteered? “I was born @nyphospital…this is home, this is my community”. Seeing how well we'd been doing @ucsf “it felt wrong not take the opportunity to support the folks here.” His compassion & bravery are awe-inspiring (as w/ the other 19).
7/ @Rutherford_UCSF highlights (@ 19:45) likely course had we not adopted stay-home. Per original Imperial College projections, we would have expected 44,484 deaths in Bay Area by summer. Current deaths in Bay Area: 170. “That’s quite a remarkable public health achievement.”
8/ How will next stage work? George (@ 24:25): “We’re far from out of woods here.” We’ll open in stages, “maybe manufacturing & construction, then retail, then entertainment… I fully expect people will...wear masks.” Sports: maybe golf & tennis, but no sports/concerts w/ crowds
9/ @KBibbinsDomingo: showed major disparities in risk of developing Covid & outcomes for infected pts. Slide (@ 34:58) on why: wealthier communities can do social distancing more easily. Take-homes @ 42:50: Covid hilites pre-existing inequities & demonstrates our interrelatedness
10/ @Annieluet on remdesivir (@ 45:10) hopeful but still not gr8 data (see #12). @nejm study showed good outcomes & acceptable safety profile, but hard to B sure w/o control group. Ditto re hydroxychloroquine, tho >concern for side effects w/ prolonged QT, could cause arrhythmias
11/ @ 58:20, IDSA->no rec for any agents outside clinical trial bit.ly/2xCuaU. @ 1:03:58, I pushed her for recs if no clinical trial availble: less positive re HCQ; more enthused re remdesivir (“lean toward giving it to critically ill pts”); convalescnt plasma in-betwen
12/ As we spoke, @statnews leaked @uchicago study: bit.ly/2ylT2jI: 113 pts w/ bad disease got IV remdesivir–only 2 died, most left hosp <6d. Again, no control. Even w/o control, if those results hold up that’s awfully promising. Gilead shares up 16%, so market believes
13/ @MKushel @ 1:06:25, on homeless shelter outbreaks in SF/Boston: “We weren’t surprised…devastating but not surprised…. Big surprise was how many were asymptomatic….always known that homeless shelters could be tinderbox.” Have to get homeless, esp. hi-risk, into shelters…
14/ In my interview w/ the 3 mayors today (this video: bit.ly/2z9dPaL) SF Mayor @LondonBreed described challenges of getting homeless into shelters (@ 17:40). I hadn’t really considered how tough this is, even with enough money & thousands of empty hotel rooms in SF.
15/ Back to Grand Rds: George: provocative answer re: antibody testing @ 1:16:38 “I’m not a great believer…remember, just because you have antibodies doesn't mean you’re immune.” Moreover, “the market is utterly confused,” with lots of tests, some of which may not be accurate
16/ @ 1:27:15: what will life be in 2021 if no vaccine. George: Looking for hot spots, “really grunt work, block by block…Overall, “Not normal but normalish.” But “if we had a great drug, it would change the calculus quite a bit.” (We hadn’t seen Remdesivir leak at that point.)
17/ Well, enough recap; if you can spare 90m (or 60 if you can do 1.5x without headache), highly recommend you watch Grand Rounds. Even if you have no medical or scientific background, you’ll learn a lot. Again, it’s at bit.ly/2yih6Ej
Happy birthday Doug!
Tomorrow...
Happy birthday Doug!
Tomorrow...
Of course, into hotels with single rooms. Sorry for the error.
